THE LAST WORD
Too little, too late “H
ad my son been given the right support and help
in the early stages of his mental illness, he would have made a complete recovery and been able to lead a full and productive life,” says the mother of a young man diagnosed with schizophrenia.
Her story is not unique and therein lies the crux of the problem with mental health services. Too little treatment, often too late, to the detriment of the individual concerned – and the public purse.
At an estimated cost of £33.75 billion each year, as well as the appalling human costs, mental illness is a significant economic burden. Yet the impact isn’t only on the NHS. The absence of decent, cost effective treatment in the early stages means that people become more unwell and that their difficulties go on for longer. The knock on impact can result in homelessness, ongoing unemployment and even encounters with the criminal justice system.
But finding out what people affected by mental illness need – and lack – isn’t rocket science. Our recent survey of 441 service users found that only one in six receive all the treatments recommended by the National Institute for Health and Clinical Excellence.
It just isn’t good enough that only half (51%) of people with schizophrenia and bipolar disorder have been offered psychological therapy – not when its benefits can be so profound.
David, a Rethink supporter and Oxford academic who developed
96 nhe Paul Jenkins
schizophrenia during his doctorate, rues the fact that he had to wait 10 years for cognitive behavioural therapy. “It could have prevented a lot of suicide attempts and I wouldn’t have felt so awful for so long,” he says.
Nor is it acceptable that only one in three mental health service users are offered an annual physical health check. People with severe mental illness die up to 10 years younger than the rest of the population, often from preventable illnesses.
A regular physical health check would help detect changes in people with schizophrenia, who are 90% more likely to develop bowel cancer and 42% more likely to develop breast cancer.
And it’s not just service users who think things need to improve. A Rethink survey of 251 GPs revealed a distinct lack of faith in the quality of mental health services. Nearly all the
doctors (95%) were confident about the care their relatives would receive for cardiovascular disease but fewer than a quarter (22%) felt the same about treatment for post traumatic stress disorder. Worse still, many GPs worry that patients with psychosis will actually come to harm while waiting for a specialist assessment.
So change is clearly needed but how can we afford to improve mental health services at a time when budgets are at full stretch?
For a start, it’s a misnomer to suggest that decent treatment comes at a higher price. A wealth of evidence shows that the right treatment at the right time saves money. Offering CBT to people with schizophrenia saves around £1,000 per person and for psychosis appropriate early intervention can save nearly £5,000 per person.
From a policy perspective there’s plenty the government can do immediately, starting with an effort to address the disparity between mental and physical health.
To date, mental health has been completely excluded from the NHS Choice agenda. While all other patients have the right to choose where they receive treatment, those affected by severe mental illness - along with pregnant women - are exempt.
Extending the Choose and Book system to all patients would help to address this.
Similarly, mental health services need to be included in Payment by Results. Without a framework setting out predicted costs for mental health, trusts can reduce their spending on mental health services without fear of reproach.
And the health secretary’s plans to give GPs more responsibility for commissioning mental health services provide cause for concern. By their own admission, GPs lack the required expertise - while three quarters feel confident in commissioning services for asthma and diabetes, a mere three in ten feel the same about mental health. It would be unwise to progress this plan without devising a training programme to equip GPs with appropriate skills.
In its ten years of existence, the National Service Framework achieved great strides in mental health and the coalition government now has the opportunity to build on the solid foundations already in place.
That improvement needed is clear. Failing to act will be to the detriment of everyone affected by severe mental illness.
Paul Jenkins is chief executive of Rethink
Rethink has launched Fair Treatment Now, a campaign to improve mental health services. The charity wants to see:
- Increased access to psychological therapies - National outcome measures to assess death and recovery rates - A national tariff for mental health services through Payment by Results - Training for GPs so that they are able to commission for severe mental illness - NHS patients to be able to choose their provider through Choose and Book - Healthwatch to focus on patients with severe and enduring conditions
For more information go to
www.rethink.org/fairtreatmentnow Nov/Dec 10
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